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Effects on renal function after percutaneous mechanical thrombectomy using Angiojet.
Matthew R. Abate, MD, Dillon Burks, BS, Ahsan Ali, MD, Matthew R. Smeds, MD, Guillermo A. Escobar, MD.
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
OBJECTIVES:
Percutaneous mechanical thrombectomy (PMT) is a popular and useful tool for thrombus removal in acute thrombotic syndromes. Angiojet uses high pressure spray to break up and aspirate thrombus, in addition to delivering plasminogen activators. This is known to cause hemolysis, and all practitioners have noted periprocedural hematuria. Despite this, to our knowledge, there is no study evaluating the consequences to renal function after using this device. We sought to determine the incidence of acute kidney injury, and associated risk factors after using Angiojet for thrombolysis.
METHODS:
With IRB approval, we retrospectively reviewed a prospectively-maintained database of all patients managed by the Vascular Surgery service from 2009-2012 with procedural codes describing thrombolysis (CPT 37201, 37187, 37209 and 75898), and/or Percutaneous Mechanical Thrombectomy (CPT 37187). We identified those treated with Angiojet and reviewed demographics, indications, laboratory values before and after the procedure (up to 3 days) and determined the incidence of acute kidney injury (AKI). AKI was defined as an increase in creatinine (Cr) >25% of baseline within 24-72hrs. Patients on dialysis before Angiojet, or without lab values before and 24-72hrs after treatment were excluded.
RESULTS:
144 lysis procedures were identified, and 53 were treated with Angiojet. Average age was 50 (range 87-20, median 49). Arterial thrombus was the indication in 68%; venous in the rest. AKI occurred in 15/53 (28%). Baseline Cr in AKI and non-AKI patients was similar, while Cr after Angiojet was not (p=0.01). Only 4 patients had a baseline Cr >1.4 (two in each group). Average age of AKI group was 54 (range 36-74, medium 49), 47% were male, and only one had a baseline Cr >1.4mg/dL (NS for all). Average creatinine increase from baseline in AKI group was 0.5mg/dL (167% rise p=0.003) compared to -0.07mg/dL (NS) in non-AKI patients. When compared to 53 lysis cases that did not use Angiojet, Cr change in Angiojet’s group was higher (p=0.03).
CONCLUSIONS:
This preliminary study suggests that AKI may occur in over one quarter of patients treated with Angiojet, independently of traditional risk factors for AKI (diabetes, baseline creatinine and age). This risk may be due to hemolysis, and is under-reported in the literature. Prospective studies and long-term consequences should be undertaken to better define this risk.
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